AANA journal
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The analyses of malpractice closed claims conducted by the AANA Foundation Closed Claims Research Team are scientific studies of adverse anesthetic events where a Certified Registered Nurse Anesthetist was identified as potentially contributing to the outcome. From July 2013 to March 2014, the AANA Foundation Closed Claims Researchers evaluated 245 closed claims from the CNA Insurance Companies spanning from 2003 to 2012. ⋯ The purpose of the study was to establish themes that would provide unique insights into the events leading up to death with a focus on the role anesthesia may or may not have had in the outcome. Major themes identified include: (1) patient factors, (2) provider factors, (3) environmental factors, and (4) team/group factors.
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Residual neuromuscular blockade creates excess perioperative morbidity. Quantitative neuromuscular monitoring devices may help ensure full recovery from neuromuscular blocking agents and have been demonstrated to reduce complications associated with residual neuromuscular blockade. We studied the effectiveness of educational efforts to introduce quantitative monitoring at a large academic medical center, with predefined main outcome measures of self-reported familiarity with use of the device and actual device uptake. ⋯ Clinical utilization of the monitors increased from 23% to 40% of eligible cases, with the increased rate sustained in the follow-up period. Education, assessed as improved self-reported proficiency, was associated with measurable increases in utilization of new technology. However, the rate of uptake, even when applied to a problem the users agreed was important, was modest.
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Some surgeries present increased challenges for adequate perioperative pain management, which require innovative methods to prevent development of chronic postsurgical pain (CPSP). Ketamine is an adjunct to traditional pain management methods and is an effective analgesic. The potent antihyperalgesic effects of ketamine represent an interesting option for those searching for multimodal approaches. ⋯ This multimodal approach controlled the patient's pain postoperatively without reported complications. At his 1-year postsurgical follow-up visit, the patient reported some generalized "dull aching pain" that was well controlled with oral ibuprofen. Overall, the patient was satisfied with his pain control, and CPSP did not develop.
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The "handoff" phase of patient care is frequently associated with the genesis of adverse events. Patient handoffs in anesthesia care remain poorly studied. By reviewing archived video of anesthesia handoffs taking place in a simulated environment, we aimed to identify latent conditions and their impact on the quality and nature of handoffs occurring during surgical anesthesia care. ⋯ Handoffs were often good or excellent with 0, 1, or 2 latent conditions present, but with 3 or more latent conditions, the quality invariably degraded. When handoff scores were high, the handoffs were always interactive. This is the first study to relate specific latent conditions to handoff quality, providing a foundation for future research, as well as for the education and training of anesthesia providers.
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This guest editorial reviews the facts surrounding the current opioid overdose crisis in the United States, including the history of opioid use and abuse leading up to the current crisis, and the impact of the crisis on the healthcare system. The editorial concludes with concrete recommendations and actions that Certified Registered Nurse Anesthetists (CRNAs) can take to combat this deadly and tragic epidemic. As leaders in the healthcare system and experts in opioid use and pain management, CRNAs have a moral and professional obligation to help patients and families affected by opioid misuse in any way possible.